The Global Network of Sex Work Projects (NSWP), implemented a global project to identify and document best practices undertaken by sex workers in carrying out programmes related to sex work and HIV; to identify and document issues of sex workers and their access to HIV‑related treatment and the impact of free trade on this access; and to identify and document the impact of programmes relating to HIV directed at sex workers which fail to include a human rights‑based approach.

The five regional reports document twenty good practice examples of sex worker-led HIV programming in twenty countries. The Global Report combines the good practice examples identified in the Regional Reports to illustrate the success of sex worker-led HIV programming around the world.

To date less than 1% of global funding for HIV prevention has been spent on HIV and sex work (UNAIDS, 2009), yet concerns about HIV and other sexually transmitted infections (STIs) are among those invoked to justify laws and policies which contribute to the multiple human rights violations suffered by sex workers worldwide. Paradoxically, these violations serve to put sex workers’ lives at risk, including with regard to their sexual health. The barriers to health faced by sex workers are manifold, ranging from police confiscation of their condoms for use as evidence against them, to hate crimes against sex workers encouraged by widespread stigma which paints them as ‘vectors of disease’, and health care services which may be overly expensive, disrespectful of confidentiality, inaccessible to undocumented migrants, or conditional upon a commitment to leave the sex industry.

Around the world, sex worker-led organisations are succeeding, some against great odds, in delivering HIV programming which takes into account the complexities of sex work and recognises the essential need for direct consultation with, and the active involvement of, the intended beneficiaries of services. Their pragmatic approach is typically characterised by a non-judgemental attitude, an intersectional analysis of oppression, and a firm commitment to the demand “nothing about us without us”. In taking this approach, they have gained the trust of the sex workers they serve and have seen genuine improvements in their holistic health, including decreased rates of HIV and other STIs and access to appropriate treatment for HIV-positive sex workers. Some of the organisations profiled in this report have made significant headway in making local health care and social service providers, along with law enforcement officers, aware of the sometimes complex issues affecting sex workers, resulting in more effective and welcoming services. Despite these successes, the organisations themselves often operate on a shoestring budget and in an unfavourable political climate which sees widespread stigma and hostility towards sex workers and other marginalised groups.

The objective of the global project was two-fold:

to document the experiences of sex workers, through examples of best practices that serve to share the development of politically influential tools; to strengthen sex workers’ group efforts to become effectively involved in the development of policies and programmes that help to amplify their voices both at regional and international levels; and

to document the access of sex workers to treatment, as well as the impact of HIV programmes which fail to include a human rights-based approach, such as highly coercive or mandatory HIV programmes, as well as the lack of access to affordable and effective treatment for HIV and STIs.